To link to the entire object, paste this link in email, IM or documentTo embed the entire object, paste this HTML in websiteTo link to this page, paste this link in email, IM or documentTo embed this page, paste this HTML in website

The impact of public expenditures on health care on total health expenditures: an exploratory analysis of selected OECD countries

THE IMPACT OF PUBLIC EXPENDITURES ON HEALTH CARE ON TOTAL HEALTH EXPENDITURES:
AN EXPLORATORY ANALYSIS OF SELECTED OECD COUNTRIES
by
Bart Verbelen
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(PUBLIC ADMINISTRATION)
December 2007
Copyright 2007 Bart Verbelen

This study has three parts. First, health care systems are analyzed along their key organizational, financing and delivery characteristics. Next, trends in total health expenditures, source of financing, expenditure structure and technology are described. The combined results show that the United States' health care system very similar to other health care systems with respect to organizational and delivery characters but substantially differs from the other health care systems in terms of financing mechanism. In addition, the United States has much higher total health expenditures and a much smaller public share of total health expenditures than any other country included in this study.; Finally, based on the findings from the descriptive analysis and building on previous research, a multivariate analysis using fixed effects focuses on the relationship between total health expenditures and public share of health care system in nineteen OECD countries over a thirty-year period. This analysis differs from previous research in two ways. First, this analysis includes a sensitivity analysis to test the robustness of the models and, different models are tested separately as well as in one model. While GDP remains the most important explanatory variable, public share is inversely related to total health expenditures. Public integrated health care systems relying predominantly on public provision have an expenditure-increasing effect, supporting the public choice theory. Third, consistent negative estimates are obtained for share of health expenditures spent on pharmaceuticals, supporting the substitution theory. Out of pocket payments have an expenditure decreasing influence. Global budgets can contain expenditures while DRGs do not. System that predominantly use fee for service remuneration, have higher total expenditures compared to other payment methods. Finally, an ageing population and increased urbanization are positively related to total health expenditures. Public integrated health care systems relying predominantly on public provision have an expenditure-increasing effect, supporting the public choice theory. Third, consistent negative estimates are obtained for share of health expenditures spent on pharmaceuticals, supporting the substitution theory. Out of pocket payments have an expenditure decreasing influence. Global budgets can contain expenditures while DRGs do not. System that predominantly use fee for service remuneration, have higher total expenditures compared to other payment methods. Finally, an ageing population and increased urbanization are positively related to total health expenditures.

THE IMPACT OF PUBLIC EXPENDITURES ON HEALTH CARE ON TOTAL HEALTH EXPENDITURES:
AN EXPLORATORY ANALYSIS OF SELECTED OECD COUNTRIES
by
Bart Verbelen
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(PUBLIC ADMINISTRATION)
December 2007
Copyright 2007 Bart Verbelen